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Abuse and neglect during childhood are linked to poor mid-adulthood socioeconomic outcomes, with greater risk for those who experienced multiple types of maltreatment.

Note that the study findings argue for support for programs for remedial inputs to cognitive skills and development of children who have been neglected.

Abuse and neglect during childhood are linked to poor mid-adulthood socioeconomic outcomes, with greater risk for those who experienced multiple types of maltreatment, researchers reported.

According to findings from a population-based study of 8,076 adults in the U.K., 21% experienced one type of maltreatment and 10% experienced two or more types during childhood, wrote Snehal M. Pinto Pereira, PhD, of the University College London Institute of Child Health, and colleagues in Pediatrics.

Of these individuals who reported neglect and abuse, there was a greater risk of time off from work due to long-term sickness and a lower risk of home ownership in middle age compared with others.

Furthermore, the risk of a poor adult socioeconomic outcome was greatest for people who experienced multiple types of child maltreatment. For example, the adjusted odds ratio for long-term sickness absence increased from 1.0 to 1.76 (95% CI 1.32-2.35) to 2.69 (95% CI 1.96-3.68), respectively, for zero, one, and two or more types of maltreatment.

"Maltreated children are more likely to grow up to face socioeconomic disadvantage in their adult lives, with an impact that may persist for decades. This is important because such disadvantage could in turn influence the health of individuals affected and also that of their children," Pereira told MedPage Today.

In an accompanying editorial, Kristine A. Campbell, MD, of the Primary Children's Hospital Center for Safe and Healthy Families of the University of Utah in Salt Lake City, and colleagues wrote that "the findings, particularly those prospectively collected on neglect, add to growing evidence that child maltreatment contributes significantly to the trajectory of a child's life."

Pereira and colleagues examined data from the 1958 British birth cohort, a longitudinal study that followed the lives of more than 17,000 people born in England, Scotland, and Wales in a single week during 1958.

The team specifically analyzed child neglect and abuse in order to identify differences in employment, financial stability, social class, and social mobility at ages 23 and 50 after adjustment for early-life confounders, as well as potential mediating pathways via adolescent cognition and mental health.

Information was collected throughout childhood (at birth and at 7, 11, and 16 years) and adulthood (at 23, 33, 42, 45, and 50 years) from individuals, as well as parents, teachers, and school doctors and nurses.

The prevalence of child maltreatment among participants varied for sexual abuse (1%), physical and witnessing abuse (6%), and psychological abuse (10%), with 16% identifying as neglected, the researchers reported.

Using logistic regression, they concluded that when examined separately, all types of child maltreatment were linked to an increased risk of adult long-term sickness, unemployment, lack of assets, and financial insecurity.

Sexual and nonsexual abuse were both associated with several outcomes, with associations little affected by potential mediating factors. For example, for sexual abuse, the adjusted odds ratio of income-related support was 1.75 (95% CI 1.12-2.72).

Neglect was also linked to several adult outcomes -- such as being unemployed and education or training (aOR 1.43; 95% CI 1.10-1.85) -- with associations mediated by cognition and mental health.

The researchers gleaned several key conclusions about the long-term effects of childhood abuse and neglect: "Associations were mostly robust after adjustment for other early life factors, including social class and parental education, and risk of unfavorable outcomes increased with multiple types of maltreatment."

Additionally, the team emphasized that their study "elucidates some important mechanisms underlying child maltreatment -- adult outcome associations by showing that adolescent cognitive ability had a predominant mediating role in neglect associations with several adult outcomes, whereas cognition and mental health had negligible mediating effects for sexual and nonsexual abuse associations."

According to the researchers, "their findings argue for support for programs for remedial inputs to cognitive skills and development of children who have been neglected."

In the editorial, Campbell and colleagues also discussed the power of policy, but emphasized the importance of agreeing on policy priorities. "Policies that simply ask more of our colleagues in often underfunded child welfare agencies because of ever widening definitions of child maltreatment help no one."

"We should all work toward effective, evidence-based policies to address child health, and that begins by not collapsing the full spectrum of social determinants of health under one umbrella term: child maltreatment."

The study was funded by the Department of Health Policy Research Programme through the Public Health Research Consortium and supported by the National Institute for Health Research Biomedical Research Centre at Great Ormond Street Hospital for Children NHS Foundation Trust and University College London.

Campbell reported that her institution receives financial compensation for expert witness testimony provided in cases of suspected child abuse, for which she is subpoenaed to testify.

The other researchers reported no financial disclosures of interest.

Reviewed by Robert Jasmer, MD Associate Clinical Professor of Medicine, University of California, San Francisco and Dorothy Caputo, MA, BSN, RN, Nurse Planner

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